ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1678712
This article is part of the Research TopicA Patient-Centered Approach to the Management of Heart Failure and ComorbiditiesView all 10 articles
Systolic pulmonary artery pressure to define pulmonary congestion in acute heart failure without severe tricuspid regurgitation
Provisionally accepted
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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Background and Aims: Pulmonary and/or peripheral venous congestion defines the clinical diagnosis of acute heart failure (AHF). However, the systolic pulmonary arterial pressure (sPAP) thresholds at which pulmonary (chest X-ray) and inferior vena cava (IVC) congestion occur are not well established. This study aimed to identify a cut-off value of sPAP that reliably indicates AHF. Methods and Results: We retrospectively included 380 consecutive patients hospitalized for AHF at an Italian referral centre, excluding those with severe tricuspid regurgitation. Receiver operating characteristic (ROC) curve analysis and Youden's J statistic identified a threshold of sPAP ≥ 48.75mmHg as the most accurate in predicting both pulmonary (sensitivity = 89.9%, specificity = 73%) and peripheral (sensitivity = 88.3%, specificity = 82.5%) fluid overload. The association between this sPAP threshold and both pulmonary and peripheral congestion was confirmed by chi-square testing (p < 0.001) and multivariate logistic regression (p < 0.001). After adjustment for confounders, sPAP ≥ 49 mmHg was independently associated with all-cause death or heart failure (HF) hospitalization (HR = 1.713; 95% CI 1.127–2.602; p = 0.012). Conclusions: AHF decompensation is characterized by at least moderately elevated sPAP values.
Keywords: acute heart failure, Echocardiogram, Systolic Pulmonary Artery Pressure, Central Venous Pressure, critical care cardiology
Received: 03 Aug 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Bellicini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maria Giulia Bellicini, Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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